Anesthesia Induction Time Research Articles

Anesthesia, Sedation, and Unplanned Extubation of Tracheal Intubation in Children with Severe Pneumonia.

We randomly divided 200 children with severe pneumonia who met the indications for tracheal intubation into 2 groups in this prospective study. One group that received dexmedetomidine for sedation was recorded as the dexmedetomidine group (n = 100), and the group that received midazolam for sedation was recorded as the midazolam group (n = 100). We compared the anesthesia sedation scores, time to fall asleep, time to wake up from anesthesia, related hemodynamic parameters, and adverse reactions between the two groups of children. The failure mode and effect analysis method (FMEA) was also used to investigate the causes of unplanned extubation (UEX) of tracheal intubation in 32 children with severe pneumonia. Our conclusion is as follows: (1) Compared with midazolam, the comprehensive effect of dexmedetomidine on children with severe pneumonia undergoing tracheal intubation for anesthesia and sedation is better, it can effectively shorten the anesthesia induction time and the recovery time after stopping the drug, and there are few adverse reactions, which is worthy of application and promotion. (2) UEX is an important risk factor in the monitoring and nursing of children with severe pneumonia tracheal intubation, and the nursing method of PDCA cycle management is particularly important for them.

USE OF TRICAINE METHANESULFONATE, CLOVE OIL AND 2-PHENOXYETHANOL FOR IMMERSION EUTHANASIA OF UNGA CICHLIDS (SAROTHERODON LINELLII).

Fish may warrant euthanasia for a variety of reasons, but euthanasia may be difficult to accomplish or confirm because fish can recover from deep anesthesia even after cardiac and respiratory arrest. The efficacies of three types of anesthetics were evaluated to compare their suitability for euthanasia of Unga cichlids (Sarotherodon linellii). Thirty cichlids were randomly assigned to be immersed in one of the three anesthetic solutions: tricaine methanesulfonate (MS-222), 2-phenoxyethanol (2-PE), and clove oil (CO) at doses of 1,000 mg/L, 2 mL/L, and 500 mg/L respectively. The opercular rates and caudal fin stroke rates were quantified, and the time to cessation of physiological measures (CPM) including caudal fin strokes, the reaction to external stimuli, the righting reflex, swimming, and operculation were recorded. Varying anesthetic induction times were observed with all three euthanasia solutions; the time to CPM in the 2-PE group occurred at a significantly slower rate than in the MS-222 group (P < 0.01). No significant differences were identified for the time to CPM when comparing the standard length or weight of the cichlids in all euthanasia solutions (P > 0.05). The cost of euthanasia per cichlid was calculated, with the most economically viable option being 2-PE; at more than seven times the price of 2-PE, MS-222 was the most expensive. After a 60-min immersion in the euthanasia solution, the presence of an audible heartbeat was identified in 100% of the cichlids immersed in 2-PE, 100% immersed in CO, and 90% in MS-222, indicating that they were not reliably euthanized. Therefore, a two-step protocol is recommended in cichlids for euthanasia: heavy anesthesia via immersion followed by an intravenous or intracardiac injection of euthanasia solution, or other secondary method of euthanasia.

Application and Efficiency of Transnasal Humidified Rapid-Insufflation Ventilatory Exchange in Laryngeal Microsurgery.

This study aimed to analyze the feasibility of transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) during laryngeal microsurgery (LMS) and investigated its efficiency and application according to the location of the lesion. Retrospective chart review. Patients over 20 years of age who underwent LMS without underlying cardiac, pulmonary, or cerebrovascular disease were retrospectively reviewed. Overall, 54 patients with endotracheal intubation (ETI) and 44 patients with THRIVE were included. The operation and anesthesia time, induction and emergence time, oxygen saturation (SpO2 ), and transcutaneous carbon dioxide (TcCO2 ) levels were analyzed and compared between the two ventilation methods according to disease subsite. Compared with ETI, patients with THRIVE presented reduced operation time (16.3 ± 9.69 min vs. 21.9 ± 12.0 min), anesthesia time (33.6 ± 11.4 min vs. 45.4 ± 13.9 min), emergence time (6.73 ± 2.49 min vs. 8.52 ± 3.17 min), without significant decreases in SpO2 but with increased TcCO2 (10.9 ± 6.12% vs. 7.33 ± 3.86%). Comparing THRIVE to ETI for lesions at the glottis yielded similar findings, which were particularly more significant. However, lesions above the glottis presented no significant difference for any parameters between THRIVE and ETI groups. Lesions involving multiple subsites and prolonged operation time were risk factors for the intraoperative conversion of ventilation method. THRIVE is reliable for maintaining oxygenation during LMS and is efficient in reducing the operation and emergence times, leading to shorter anesthesia time, especially for lesions at the glottis. However, caution is required administering THRIVE, when lesion involves multiple subsites, and when operation time is prolonged. 3 Laryngoscope, 132:1061-1068, 2022.

Determination of the average intraocular pressure values, optimum anesthesia dose and phenotypic characteristics in Oscar fish (Astronotus ocellatus)

This research was carried out to determine the intraocular pressure values, optimum anesthesia dose and phenotypic characteristics in Oscar fish (Astronotus ocellatus). A total of 11 adult, male Oscar fish were used in the study. Optimum anesthesia dose, pre-and post-anesthesia intraocular pressure values and phenotypic measurements (total length, fork length, standard length, dorsal fin base length, head length, body length, eye diameter, body depth, pectoral length, pelvic fin bottom length, anal fin bottom length) were determined and reference values specific to this fish species were obtained by performing a statistical analysis. When exposed to 3 cc/L of the concentrations, fish achieved a deep state of anesthesia (induction time 1.31 min; recovery time 6.42 min). The most balanced anesthesia without risking vital functions was achieved using Clove oil with a dose of 2.5 cc/L. Compared to the other dimensions, total length, fork length and standard length were the most consistent body measurements with high positive correlations. No statistically significant difference (p &gt; 0.05) was seen in both eyes between the intraocular pressure values before (5.36-5.86) and after (5.59-5.36) anesthesia. It is recommended that the ideal concentration of clove oil was 2.5 cc/L to reduce stress and injury damage during handling procedures. Additionally, intraocular pressure values, body measurements and Clove oil optimum anesthesia dose obtained in this study can be used as reference values for Oscar fish raised in aquarium conditions.

Effect of fish weights and clove powder levels on anesthesia and recovery time in common carp Cyprinus carpio L.

This study aimed to demonstrate how different fish weights and clove powder concentration levels together influence anesthesia and recovery time in Cyprinus carpio. Two different body weights classes of common carp (45±5g and 95±5g) were subjected to three concentrations of clove powder (200, 300 and 400mg/L) each replicated four times. At each treatment combination, the anesthetic induction and recovery times were recorded, fish held for a period of one week to two months following the experiments to assess short-term and long-term mortality. Significant differences (P&lt;0.05) appeared in the effect of combination between the different levels of clove powder (mg/L) with the two different weight common carp (C. carpio L.) on anesthesia time, but there was no difference in recovery time between the two size groups. The induction time was less than one minute for doses of 300 and 400 mg/L in lower fish weight 45±5g while in 200mg/L dose with 95±5g of fish weight it needed more than 9 minutes. At all tested concentrations, induction time was significantly weight-dependent (p&lt; 0.05), but the recovery time was not. Significant alterations were recorded in the hematological variables of the fish (RBC, HB, MCH and WBC), no mortality was observed. This study has demonstrated that clove powder can be safely and effectively use in the anesthesia of common carp and anesthesia time affect by doses of clove powder with fish weight.

Tranexamic acid in patients with complex stones undergoing percutaneous nephrolithotomy: a randomised, double-blinded, placebo-controlled trial.

To assess the efficacy and safety of single-dose tranexamic acid on the blood transfusion rate and outcomes of patients with complex kidney stones undergoing percutaneous nephrolithotomy (PCNL). In a randomised, double-blinded, placebo-controlled trial, 192 patients with complex kidney stone (Guy's Stone Scores III-IV) were prospectively enrolled and randomised (1:1 ratio) to receive either one dose of tranexamic acid (1 g) or a placebo at the time of anaesthetic induction for PCNL. The primary outcome measure was the occurrence rate of perioperative blood transfusion. The secondary outcome measures included blood loss, operative time, stone-free rate (SFR), and complications. ClinicalTrials.gov identifier: NCT02966236. The overall risk of receiving a blood transfusion was reduced in the tranexamic acid group (2.2% vs 10.4%; relative risk, 0.21, 95% confidence interval [CI] 0.03-0.76, P = 0.033; number-needed-to-treat: 12). Patients randomised to the tranexamic acid group had a higher immediate and 3-month SFR compared with those in the placebo group (29% vs 14.7%, odds ratio [OR] 2.37, 95% CI 1.15-4.87, P = 0.019, and 46.2% vs 28.1%, OR 2.20, 95% CI 1.20-4.02, P = 0.011, respectively). Faster haemoglobin recovery occurred in patients in the tranexamic acid group (mean, 21.3 days; P = 0.001). No statistical differences were found in operative time and complications between groups. Tranexamic acid administration is safe and reduces the need for blood transfusion by five-times in patients with complex kidney stones undergoing PCNL. Moreover, tranexamic acid may contribute to better stone clearance rate and faster haemoglobin recovery without increasing complications. A single dose of tranexamic acid at the time of anaesthetic induction could be considered standard clinical practice for patients with complex kidney stones undergoing PCNL.

Dorsal raphe serotonergic neurons promote arousal from isoflurane anesthesia.

AimsGeneral anesthesia has been widely applied in surgical or nonsurgical medical procedures, but the mechanism behind remains elusive. Because of shared neural circuits of sleep and anesthesia, whether serotonergic system, which is highly implicated in modulation of sleep and wakefulness, regulates general anesthesia as well is worth investigating.MethodsImmunostaining and fiber photometry were used to assess the neuronal activities. Electroencephalography spectra and burst‐suppression ratio (BSR) were used to measure anesthetic depth and loss or recovery of righting reflex to indicate the induction or emergence time of general anesthesia. Regulation of serotonergic system was achieved through optogenetic, chemogenetic, or pharmacological methods.ResultsWe found that both Fos expression and calcium activity were significantly decreased during general anesthesia. Activation of 5‐HT neurons in the dorsal raphe nucleus (DRN) decreased the depth of anesthesia and facilitated the emergence from anesthesia, and inhibition deepened the anesthesia and prolonged the emergence time. Furthermore, agonism or antagonism of 5‐HT 1A or 2C receptors mimicked the effect of manipulating DRN serotonergic neurons.ConclusionOur results demonstrate that 5‐HT neurons in the DRN play a regulative role of general anesthesia, and activation of serotonergic neurons could facilitate emergence from general anesthesia partly through 5‐HT 1A and 2C receptors.

Formulation optimization, anesthetic activity, skin permeation, and transportation pathway of Alpinia galanga oil SNEDDS in zebrafish (Danio rerio)

Alpinia galanga oil (AGO) has an anesthetic activity but its water insoluble property limits its clinical applications. The aim of the present study was to develop a self-nanoemulsifying drug delivery system of AGO (SNEDDS-AGO) to avoid the use of organic solvent and investigate AGO transportation pathway and anesthetic activity. Three optimized formulations from a contour plots of droplet size; SNEDDS-AGO-1, SNEDDS-AGO-2, and SNEDDS-AGO-3, composed of AGO, Miglyol 812, Cremophor RH 40, Capmul MCM EP, and ethanol at the ratios of 40:10:35:10:5, 40:20:15:20:5, and 60:10:15:10:5, respectively were selected as they possessed different droplet size of 62 ± 0.5, 107 ± 2.8, and 207 ± 4.3 nm, respectively. It was found that the droplet size played an important role in fish anesthesia. SNEDDS-AGO-3 showed the longest anesthetic induction time (270 sec) (p < 0.03). Transportation pathway and skin permeation of SNEDDS-AGO-2 were investigated using nile red labelled AGO and detected by fluorescence microscope. AGO was found mostly in brain, gills, and skin suggesting that the transportation pathway of AGO in zebrafish is passing through the gills and skin to the brain. SNEDDS-AGO formulations showed significantly higher permeation through the skin than AGO ethanolic solution. In conclusion, SNEDDS is a promising delivery system of AGO.

Comparison of C-Reactive Protein Levels, Neutrophil Count, and Clinical Outcomes between Low-Dose Ketamine Given at the End of Surgery and at Induction in Laparotomy

Abstract Background: Both surgery and anesthesia can cause an inflammatory response, rise in C-reactive protein (CRP) levels in response to the acute phase, as well as the activation and increased number of neutrophils. Ketamine with the right time of administration is expected to control the inflammatory response so that it can reduce the risk of postoperative complications such as pain and reduce the use of opioids. Patients and Methods: A total of 68 patients with physical status American Society of Anesthesiologists (ASA) I–II who underwent elective laparotomy were collected by consecutive sampling. The samples were divided into 2 groups; Group A received a low dose of ketamine at the end of the surgery, and Group B received a low dose of ketamine at the time of anesthesia induction. We measured CRP level, neutrophil count, visual analog scale (VAS), as well as total morphine consumption at 24 h postoperatively. Results: The increase in CRP levels in Group A was significantly lower compared to Group B (70.8 ± 42.7 vs. 115.0 ± 44.0 mg/L, P = 0.001). Group A has a significantly lower increase in CRP levels, VAS, and the total consumption of morphine 24 h postoperatively (P &lt; 0.05). There was a strong positive between CRP and VAS (R = 0.702, P = 0.001). Conclusion: Administration of low doses of ketamine at the end of surgery was more effective in suppressing CRP levels, resulting in lower VAS score, and lower total morphine consumption in the 24-h postoperative period compared to low-dose ketamine given at the time of induction.

Activation of anterior thalamic reticular nucleus GABAergic neurons promotes arousal from propofol anesthesia in mice.

Propofol is widely used for the induction and maintenance of anesthesia, which causes a rapid loss of consciousness. However, the mechanisms underlying the hypnosis effect of propofol are still not fully understood. The thalamic reticular nucleus (TRN) is crucial for regulating wakefulness, sleep rhythm generation, and sleep stability, while the role of TRN in the process of propofol-induced anesthesia is still unknown. Here, we investigated the function of the anterior TRN in propofol general anesthesia. Our results demonstrated that the neural activity of anterior TRN is suppressed during propofol anesthesia, whereas it is robustly activated from anesthesia by recording the calcium signals using fiber photometry technology. The results showed that the activation of anterior TRN neurons by chemogenetic and optogenetic methods shortens the emergency time without changing the induction time. Conversely, chemogenetic or optogenetic inhibition of the TRN neurons leads to a delay in the recovery time. Our study showed that anterior TRN is crucial for behavioral arousal without affecting the induction time of propofol anesthesia.

Evaluation of the application of seaweed (Eucheuma cottonii) extract as fish anesthetic agent

Fish anesthetics have been a long time applied for handling and transporting fish. Eucheuma cottonii has been well known as antibacterial, antioxidant, and anti-cancer, and it is possible to be used as fish anesthetics due to the content of flavonoids and saponins. The pharmacologic properties of E. cottonii are very well documented. This study aimed to investigate the anesthetic potency of E.cottoni extract including its induction time, recovery time, the power of anesthetic, and the phenol absorption by fish, as well as determining their mathematical models. This study was conducted by immersing fish in solutions of varying concentrations of E. cottonii (30, 40, and 45% v/v). The immersed fish were then observed for anesthetic induction time, anesthetic recovery time, power of anesthetics, and phenol absorption of the fish. The results of the experiment show that the E.cottonii extract could anesthetize Oreochromis niloticus with the best concentration of 45% (v/v) with an induction time of 3.00 ± 1.41 min and recovery time of 3.22 ± 1.62 min. The induction time followed the exponential model with the equation y = 936449e − 0.282 × (R2 = 0.9993). The recovery time followed the exponential equation with the equation y = 0.0208e0.1075 × (R2 = 0.9025). The anesthesia power followed the logarithmic model for induction time with the equation y = − 541.5ln(x) + 2135.7(R2 = 0.9025) and exponential model for recovery time with the equation y = 0.0165e0.1243 × (R2 = 0.9738). This study shows that E. cottonii could be used as an anesthetic in Oreochromis niloticus. And that at a concentration of 45% v/v, E. cottonii could produce an anesthetic effect with a duration of 4 h. The model of phenol absorption was pseudo-second-order for all concentration.

Intraoperative Hypertension is Associated With Postoperative Acute Kidney Injury After Laparoscopic Surgery

Background: It is well demonstrated that the intraoperative blood pressure is associated with postoperative acute kidney injury (AKI); the association between increasing magnitude and duration of intraoperative hypertension with AKI in patients undergoing laparoscopic surgery remains unknown, however. Methods and Findings: This retrospective cohort study included 12,414 patients aged ≥18 years who underwent a single elective laparoscopic surgery during hospitalization between October 2011 and April 2017. Multivariate stepwise logistic regressions were applied to determine the correlation between intraoperative hypertension and postoperative AKI.Results482 hospitalized patients (3.9%) developed surgery-related AKI. Compared with those without acute intraoperative hypertension (IOTH) or with normal mean MAP (70-75 mmHg), acute elevated of IOTH (odds ratio, OR, 1.4, 95% CI, 1.1 to 1.7), mean MAP ≥95 mmHg (OR, 1.8; 95% CI, 1.1 to 2.9), MAP 100-105 mmHg (OR, 1.8; 95% CI, 1.1 to 3.1), and more than 105 mmHg (OR, 2.4; 95% CI, 1.4 to 4.0) were independent of other risk factors in a diverse cohort undergoing laparoscopic surgery, especially during the time of anesthesia induction and skin incision. In addition, the risk of postoperative AKI appeared to result from the long periods (≥20 min) exposure of intraoperative hypertension (OR, 1.9; 95% CI, 1.5 to 2.5). Conclusions: Postoperative AKI correlates positively with intraoperative hypertension in patients undergoing laparoscopic surgery. These findings provide an intraoperative evaluation criterion to predict the occurrence of postoperative AKI. Funding Information: The study was supported by the National Natural Science Foundation of China (81901842), the Teachers and Students Innovation Funds of Central South University (2018gczd011), Scientific research project of Hunan health and Family Planning Commission (20201802) and the National Key R&D Program of China (2018YFC2001800). Declaration of Interests: The authors declare that they have no competing interests. Ethics Approval Statement: This study was approved by The institutional review board (IRB) of The Third Xiangya Hospital (No. 2018-S375). And the requirement for written informed consent was waived by the IRB. This study protocol conformed to the ethical guidelines of the 1975 Declaration of Helsinki and Ethical review method of biomedical research involving human (2016).

Protective Role of ECMO on Reperfusion Injury and Acute Rejection in Lung Transplantation: A Pathological Analysis

Purpose The routine utilization of intraoperative extracorporeal membrane oxygenation (ECMO) in lung transplantation is recently extensively investigated for its protective role, especially on reperfusion injury. The purpose of this study is to compare pathological features on pre and post-reperfusion biopsies and on 30 and 90-days surveillance trans-bronchial biopsies in lung transplantations performed with or without ECMO support to assess its protective role on the graft Methods 51 patients (13 with ECMO support, 38 without ECMO support) underwent bilateral lung transplantation at our Institution between 2012 and 2019. Only patients on ECMO at time of anesthetic induction or before the first clamping of the pulmonary artery were included. Patients submitted to graft volume reduction before lung reperfusion were excluded from the analysis.Intra-operative pre and post-reperfusion biopsies were collected to analyze edema, leucocyte margination and congestion/extravasation (score 0-3). The presence of acute rejection (grade A0-3, grade B0-2) diffuse alveolar damage (DAD), organizing pneumonia (OP) on 30 and 90-days trans-bronchial surveillance biopsies was also compared in the two groups. Results No significant differences were found between the two groups in terms of edema, leucocyte margination and congestion in pre reperfusion biopsies. On post reperfusion biopsies, leucocyte margination was significantly less frequent in ECMO group (46% vs 76%; p=0.043). A lower frequency of acute rejection (grade A0-3) was also found in the ECMO group on 30-days biopsies (25% vs 58%, p=0.047). Conclusion In conclusion, this analysis does not show significant differences between the two groups except for a lower frequency of leucocyte margination at post-reperfusion biopsies and acute rejection at 30-days biopsies in the ECMO group. Other studies, with a larger population, are needed in order to evaluate whether the positive clinical impact of using ECMO as a prevention of reperfusion edema after lung transplantation can also be explained by a defined pathological picture

Propofol-loaded nanomicelle with improved anesthetic, pharmacokinetic, hemocompatibility, safety, and permeation profiles

Propofol is known as one of the most potential anesthetics which suffer from limited duration of anesthesia water insolubility. Therefore, in the present study, a formulation of propofol- carboxylic acid-poly [ethylene glycol (COO-PEG)]-b-poly[ D,L lactide (PDLA)]-nanomicelle was developed and its characterization was done by transmission electron microscopy (TEM) and dynamic light scattering analysis (DLS) studies. Afterwards, drug release assay was carried out to determine the efficacy of COO-PEG-PLDA nanomicelle in drug delivery systems. Cytotoxic, hemolytic, pharmacokinetic, and permeation assays were also followed by anesthetic efficacy of propofol- COO-PEG-PLDA nanomicelle in the rat hind paw model. The results indicated that the diameter, hydrodynamic radius and zeta potential of fabricated drug-loaded nanomicelles were 30 nm, 73.24 nm and –23.59 mV, respectively and the nanomicelles were stable for a period of 50 min. Also, COO-PEG-PLDA nanomicelle showed a sustained propofol release at physiological pH. Moreover, it was indicated that COO-PEG-PLDA nanomicelle reduced the cytotoxic and hemolytic effects of propofol and increased the steady-state flux (Jss) by 6.64 times (***P < 0.001) and the cumulative amount of propofol permeated per cm2 of esophageal epithelium after 5 h (Q5h) by 6.01 times (***P < 0.001). Furthermore, pharmacokinetic data showed that COO-PEG-PLDA nanomicelles provided several fold increases in plasma concentration of propofol compared to free propofol at different time intervals. Finally, it was shown that COO-PEG-PLDA nanomicelles improved the induction time of anesthesia, anesthesia period and walking time induced by propofol. In conclusion, it may be suggested that encapsulation of propofol into diblock copolymer nanomicelles can be developed as a new novel therapeutic strategy, facilitating future research as a topical anesthetic.

The Use of Tablet Computers to Reduce Preoperative Anxiety in Children Before Anesthesia: A Randomized Controlled Study

PurposeChildren undergoing surgery and general anesthesia often experience preoperative anxiety (POA) with related negative short-, medium- and long-term consequences. Anxiolytic premedication has negative side effects, and nonpharmacologic interventions are often resource demanding and not always readily available in a busy clinical setting. The use of an age-appropriate game on a tablet computer may reduce POA, postoperative pain, and occurrence of emergence delirium (ED). DesignChildren aged 3 to 6 years scheduled to undergo elective minor surgery were randomly assigned to play a game on a tablet computer while in the holding area before anesthesia (n = 30) or prepared as per departmental standard only (n = 30). MethodsPOA, ED, and levels of pain were assessed by the modified Yale Preoperative Anxiety Scale, Pediatric Anesthesia Emergence Delirium, and Face, Legs, Activity, Cry, Consolability scale, respectively. FindingsA total of 60 children were randomized to either the intervention group or the control group. Gender, bodyweight, duration of anesthesia and surgery, and fentanyl dosages were comparable between the two groups. Tablet-gaming children tended to be less anxious than control subjects at the time of anesthesia induction (modified Yale Preoperative Anxiety Scale, 55.7 vs 65.8; 95% confidence interval, −0.63 to 20.8; P = .066). There was no difference in occurrence of ED or pain 20 minutes after arrival in the postanesthesia care unit. ConclusionsAlthough not statistically significant, the use of an age-appropriate tablet computer game may reduce the level of anxiety at the anesthetic induction in 3 to 6 years old children undergoing elective day-case surgery. However, the occurrence of ED and levels of pain appeared unaffected. Standardization of nonpharmacologic interventions to reduce perioperative anxiety and pain is required.

Procedural times in early non-intubated VATS program - a propensity score analysis

BackgroundNon-intubated video-assisted thoracic surgery (NiVATS) has been introduced to surgical medicine in order to reduce the invasiveness of anesthetic procedures and avoid adverse effects of intubation and one-lung ventilation (OLV). The aim of this study is to determine the time effectiveness of a NiVATS program compared to conventional OLV.MethodsThis retrospective analysis included all patients in Leipzig University Hospital that needed minor VATS surgery between November 2016 and October 2019 constituting a NiVATS (n = 67) and an OLV (n = 36) group. Perioperative data was matched via propensity score analysis, identifying two comparable groups with 23 patients. Matched pairs were compared via t-Test.ResultsPatients in NiVATS and OLV group show no significant differences other than the type of surgical procedure performed. Wedge resection was performed significantly more often under NiVATS conditions than with OLV (p = 0,043). Recovery time was significantly reduced by 7 min (p = 0,000) in the NiVATS group. There was no significant difference in the time for induction of anesthesia, duration of surgical procedure or overall procedural time.ConclusionsRecovery time was significantly shorter in NiVATS, but this effect disappeared when extrapolated to total procedural time. Even during the implementation phase of NiVATS programs, no extension of procedural times occurs.

"You can't make me!" Managing adolescent dissent to anesthesia.

When adolescents require health care, the need to obtain consent from the parent/legal guardian and assent from the patient can create the potential for an ethical dilemma when these two parties are not in agreement. Here, we describe a representative and common case scenario in which both parent and adolescent patient gave consent and assent, respectively, with a full understanding of the risks and benefits of the procedure and anesthetic. At the time of anesthetic induction, however, the patient expresses that she no longer wishes to have the procedure. We identify a number of considerations that inform the ethical analysis of such cases and offer recommendations about the most appropriate path forward for a practitioner faced with a difficult decision about how to respond.

Chemical Restraining and Electroejaculation Protocols for Semen Collection in White-Lipped Peccary (Tayassu pecari)

Background: In order to reverse the White-lipped peccary decline, besides protecting its habitat and controlling hunting, it is necessary a captive breeding program. There are reports, however, on the low fertility of white-lipped peccary, making it difficult its reproduction in captivity, making artificial insemination one of the main tools to prevent the loss of genetic diversity of species kept in captivity. Information on safe methods of anesthesia and the collection of semen should be investigated. Therefore, we aimed to compare the effects of the anesthetic protocols acepromazine/ketamine and xylazine/ketamine, as well as electroejaculation protocols, for semen collection in white-lipped peccary (Tayassu pecari).Materials, Methods &amp; Results: Twelve adult male white-lipped peccaries were submitted both to the xylazine/ketamine and acepromazine/ketamine anesthetic protocols. The anesthetic induction time and duration, the degree of muscle relaxation, the time for anesthetic recovery and the quality of the animals’ recovery were evaluated. Additionally, the quality of the sedation was evaluated based on the animal’s behavior. We also evaluated the effect of drugs on erectile functions as well as the efficiency of three electroejaculation protocols with increasing or fixed voltages (2 to 4 V; 5 to 12 V; 12 V). The acepromazine/ketamine combination promotes shorter induction time, duration and recovery from anesthesia than the xylazine/ketamine association. There were no differences, however, between the tested anesthetic protocols in relation to heart rate, respiratory rate and temperature. Ejaculate was obtained from only 2 animals when using the xylazine/ketamine protocol and adoption of stimuli between 5 and 12 V, with 10 stimuli at each voltage. In turn, ejaculate was obtained from four animals submitted to the acepromazine/ketamine protocol, three of them with the adoption of stimuli between 5 and 12 V and one with the adoption of fixed 12 V stimuli, with 45 stimuli at this single voltage.Discussion: The animals presented less deep anesthesia and, consequently, worse indicators of well-being during and after the collection procedures when submitted to the xylazine/ketamine protocol compared to the acepromazine/ketamine protocol. When submitted to the acepromazine/ketamine protocol, the animals allowed the observer to approach and handle them, facilitating handling and collection of semen, in addition to promoting better indicators of animal welfare. Also, with this aforementioned protocol, the animals showed better anesthetic return. For both anesthetic protocols, the protocol of increasing stimuli from 5 to 12 V, with 10 stimuli at each voltage, resulted in penile erection and in obtaining ejaculate in a greater number of animals in relation to the other electroejaculation protocols. In turn, the use of the growing protocol 2 V to 4 V did not even cause an erection in any of the 12 animals. From the ejaculates collected from the white-lipped peccary, volumes (0.2 to 1.0 mL) and average sperm concentration (379.1 x 106 sperm/mL) were comparatively higher than those from Pecari tajacu. The white-lipped peccary (Tayassu pecari) is considered an aggressive animal, and this characteristic can explain the relatively low success in obtaining ejaculates, as aggressiveness is directly related to stress, which is an antagonist of ejaculation. Thus, we proposed to test chemical restraint with the aid of a blowgun in future studies.

Increase in Blood-Brain Barrier (BBB) Permeability Is Regulated by MMP3 via the ERK Signaling Pathway.

Background The blood-brain barrier (BBB) regulates the exchange of molecules between the brain and peripheral blood and is composed primarily of microvascular endothelial cells (BMVECs), which form the lining of cerebral blood vessels and are linked via tight junctions (TJs). The BBB is regulated by components of the extracellular matrix (ECM), and matrix metalloproteinase 3 (MMP3) remodels the ECM's basal lamina, which forms part of the BBB. Oxidative stress is implicated in activation of MMPs and impaired BBB. Thus, we investigated whether MMP3 modulates BBB permeability. Methods Experiments included in vivo assessments of isoflurane anesthesia and dye extravasation from brain in wild-type (WT) and MMP3-deficient (MMP3-KO) mice, as well as in vitro assessments of the integrity of monolayers of WT and MMP3-KO BMVECs and the expression of junction proteins. Results Compared to WT mice, measurements of isoflurane usage and anesthesia induction time were higher in MMP3-KO mice and lower in WT that had been treated with MMP3 (WT+MMP3), while anesthesia emergence times were shorter in MMP3-KO mice and longer in WT+MMP3 mice than in WT. Extravasation of systemically administered dyes was also lower in MMP3-KO mouse brains and higher in WT+MMP3 mouse brains, than in the brains of WT mice. The results from both TEER and Transwell assays indicated that MMP3 deficiency (or inhibition) increased, while MMP3 upregulation reduced barrier integrity in either BMVEC or the coculture. MMP3 deficiency also increased the abundance of TJs and VE-cadherin proteins in BMVECs, and the protein abundance declined when MMP3 activity was upregulated in BMVECs, but not when the cells were treated with an inhibitor of extracellular signal related-kinase (ERK). Conclusion MMP3 increases BBB permeability following the administration of isoflurane by upregulating the ERK signaling pathway, which subsequently reduces TJ and VE-cadherin proteins in BMVECs.

Optimized Reference Signal for Induction of General Anesthesia with Propofol

Abstract In this paper we propose the use of an optimization strategy for the computation of an optimized reference (command) input to be applied to a proportional-integral-derivative (PID) based closed-loop control system for the administration of propofol during the induction phase of general anesthesia. The bispectral index scale (BIS) is the controlled variable. The proposed methodology explicitly takes into account the dynamics of the PID controller in the calculation of the reference input to minimize the induction time of anesthesia while limiting the undershoot of the BIS level. The effectiveness of the proposed methodology is assessed in simulation by means of a Monte Carlo method and the performance is compared with that of an optimally tuned PID controller and with that of a recently devised optimized feedforward control law. The effect of the PID tuning on the obtainable performance is also investigated.